FHIR TL;DW: 9 Key Problems When Connecting to 400+ Servers

September 25, 2024

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In our FHIR TL;DW (Too Long; Didn’t Watch) series, we share bite-sized summaries and insights from key HL7 FHIR DevDays presentations.

Syncing or moving data between different FHIR servers presents significant challenges. In his talk at DevDays, “Syncing Resources Between Distributed FHIR Servers”, Joshua Kelly (CTO at Flexpa) delves into a real world application of this challenge—connecting to SMART on FHIR Patient Access APIs. I’ve outlined the key insights from the talk below.

The Challenge

Joshua’s application is designed to access patient data from hundreds of FHIR systems. You might think this could be solved by using the Patient/$everything operation to fetch all relevant patient data. However, this is complicated by the wide variability in FHIR implementation across different systems. As a result, Joshua’s team is forced to use a primitive fallback option: fetching individual resources and ‘walking’ the FHIR resource references.

Finding the Best Solution: Uploading Data to a FHIR CDR

Once they have pulled a patient’s data from the 400+ source systems they need to upload it to a FHIR CDR. They found that Batch/Transaction bundles with PUT (upsert) was the was the most reliable method. While Bulk Data Import might have been a better solution, it remains in draft status, making it less practical for immediate use.

Why Not Use the “Ideal” Solution?

A common reaction by FHIR implementers to the solution outlined above is: “..but can’t we use X?” Yes, but X is rarely supported. This forces you to layer solutions and rely on the lowest common denominator. Joshua argues that the only way to avoid having to do this is to have much stricter conformance requirements.

Learn More FHIR

At Firely, we’re committed to sharing best practices and insights for everything FHIR. For more in-depth insights and discussions on navigating FHIR challenges, explore our blog and FHIR training courses.

Interested in more talks like this? Join us and HL7 at the next FHIR DevDays, the largest FHIR-only event in the world where you can learn all about FHIR and hone your FHIR expertise. There’s plenty of content for both developers and non-coders, for FHIR starters and FHIR experts alike.

For the full length video of Joshua Kelly’s talk, you can find that here. For all videos from FHIR DevDays 2024, head over to the Devdays 2024 playlist on Youtube.

By René Spronk

René Spronk is a trainer and educator specializing in healthcare interoperability standards. He focuses on FHIR, as well as related standards such as HL7 v2 and IHE, helping organizations understand how health information can be shared effectively across systems. At Firely René works with healthcare providers, vendors, and other stakeholders, delivering training and guidance that makes complex interoperability topics accessible and practical. His work primarily focuses on Europe, where he supports organizations in understanding the European interoperability landscape and EU legislation, including the European Health Data Space (EHDS).